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Chandan P, Byrnes ME, Newey C, Hantus S, Punia V. Outpatient EEG in Routine Clinical Care of Patients With Stroke-Related Acute Symptomatic Seizure Concerns. J Clin Neurophysiol 2024; 41:312-316. [PMID: 36893378 DOI: 10.1097/wnp.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Acute symptomatic seizures (ASyS) after stroke contribute the highest risk to poststroke epilepsy (PSE) development. We investigated the use of outpatient EEG (oEEG) among stroke patients with ASyS concerns. METHODS Adults with acute stroke, ASyS concerns (underwent cEEG), and outpatient clinical follow-up were included (study population). Patients with oEEG (oEEG cohort) were analyzed for electrographic findings. Univariable and multivariable analyses helped identify predictors of oEEG use in routine clinical care. RESULTS Among 507 patients, 83 (16.4%) underwent oEEG. The independent predictors of oEEG utilization included age (OR = 1.03 [1.01 to 1.05, P = 0.01]), electrographic ASyS on cEEG (OR 3.9 [1.77 to 8.9], P < 0.001), ASMs at discharge (OR 3.6 [1.9 to 6.6], P < 0.001), PSE development (OR 6.6 [3.5 to 12.6], P < 0.001), and follow-up duration (OR = 1.01 [1.002 to 1.02], P = 0.016). Almost 40% of oEEG cohort developed PSE, but only 12% had epileptiform abnormalities. Close to a quarter (23%) of oEEGs were within normal limits. CONCLUSIONS One in six patients with ASyS concern after stroke undergoes oEEG. Electrographic ASyS, PSE development, and ASM at discharge are primary drivers of oEEG use. While PSE drives oEEG use, we need systematic, prospective investigation of outpatient EEG's role as prognostic tool for PSE development.
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Affiliation(s)
- Pradeep Chandan
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Wei W, Dong L, Ye J, Xiao Z. Current status and influencing factors of family resilience in families of children with epilepsy: a cross-sectional study. Front Psychiatry 2024; 15:1354380. [PMID: 38516257 PMCID: PMC10954834 DOI: 10.3389/fpsyt.2024.1354380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose The study was designed to describe the level of family resilience and identify the protective factors and vulnerability factors of family resilience in families of children with epilepsy. So as to provide theoretical guidance for implementing intervention programs to promote family resilience. Methods From November 2020 to July 2021, 258 parents of children with epilepsy were investigated using a convenience sampling method. The questionnaire included demographic data, Chinese-Family Resilience Assessment Scale, Social Support Rating Scale, and the Beck Depression Inventory. SPSS25.0 was used for descriptive statistical analysis, univariate analysis, and multivariate linear regression analysis. Results In this study, two hundred and fifty-eight primary caregivers completed the paper questionnaires. The total score of family resilience was (134.97 ± 16.57), which was above the medium level. Multiple linear regression analysis revealed that subjective support (β=0.327, P<0.001), comorbidity (β=0.181, P<0.05), objective support (β=0.117, P<0.05), and parental depression (β=-0.158, P<0.05) were significantly related to family resilience. These variables contribute 31.7% of the variance in family resilience (F=18.07, P< 0.001). Conclusion The families of children with epilepsy presented appropriate resilience after the children were diagnosed with epilepsy. Family resilience was correlated with multiple factors, subjective and objective support could be protective factors, comorbidity and parental depression could be vulnerability factors of family resilience. Therefore, future psychosocial interventions could focus on enhancing subjective support and objective support, reducing parental depression, and screening for epilepsy comorbidity to promote the family resilience of children with epilepsy.
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Affiliation(s)
- Wenjing Wei
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lianlian Dong
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinghua Ye
- Department of Neurology, China Medical University Shenzhen Children’s Hospital, Shenzhen, China
| | - Zhitian Xiao
- Department of Neurology, China Medical University Shenzhen Children’s Hospital, Shenzhen, China
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Hlauschek G, Nicolo J, Sinclair B, Law M, Yasuda CL, Cendes F, Lossius MI, Kwan P, Vivash L. Role of the glymphatic system and perivascular spaces as a potential biomarker for post-stroke epilepsy. Epilepsia Open 2024; 9:60-76. [PMID: 38041607 PMCID: PMC10839409 DOI: 10.1002/epi4.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
Stroke is one of the most common causes of acquired epilepsy, which can also result in disability and increased mortality rates particularly in elderly patients. No preventive treatment for post-stroke epilepsy is currently available. Development of such treatments has been greatly limited by the lack of biomarkers to reliably identify high-risk patients. The glymphatic system, including perivascular spaces (PVS), is the brain's waste clearance system, and enlargement or asymmetry of PVS (ePVS) is hypothesized to play a significant role in the pathogenesis of several neurological conditions. In this article, we discuss potential mechanisms for the role of perivascular spaces in the development of post-stroke epilepsy. Using advanced MR-imaging techniques, it has been shown that there is asymmetry and impairment of glymphatic function in the setting of ischemic stroke. Furthermore, studies have described a dysfunction of PVS in patients with different focal and generalized epilepsy syndromes. It is thought that inflammatory processes involving PVS and the blood-brain barrier, impairment of waste clearance, and sustained hypertension affecting the glymphatic system during a seizure may play a crucial role in epileptogenesis post-stroke. We hypothesize that impairment of the glymphatic system and asymmetry and dynamics of ePVS in the course of a stroke contribute to the development of PSE. Automated ePVS detection in stroke patients might thus assist in the identification of high-risk patients for post-stroke epilepsy trials. PLAIN LANGUAGE SUMMARY: Stroke often leads to epilepsy and is one of the main causes of epilepsy in elderly patients, with no preventative treatment available. The brain's waste removal system, called the glymphatic system which consists of perivascular spaces, may be involved. Enlargement or asymmetry of perivascular spaces could play a role in this and can be visualised with advanced brain imaging after a stroke. Detecting enlarged perivascular spaces in stroke patients could help identify those at risk for post-stroke epilepsy.
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Affiliation(s)
- Gernot Hlauschek
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - John‐Paul Nicolo
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Benjamin Sinclair
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
| | - Meng Law
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of RadiologyThe AlfredMelbourneVictoriaAustralia
| | | | | | - Morten Ingvar Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
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Bachir Hajji E, Traore B, Hassoune S, Bellakhdar S, El Imane Issam Salah N, Abdoh Rafai M, Lakhdar A. Knowledge, attitudes and practices towards epilepsy in morocco: A cross-sectional study. Epilepsy Behav 2024; 150:109567. [PMID: 38096661 DOI: 10.1016/j.yebeh.2023.109567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/01/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND This study aims to assess knowledge, practices and attitudes of the general Moroccan population towards epilepsy and to highlight predictive factors. METHOD A cross-sectional study was conducted in the Casablanca-Settat Moroccan region. A questionnaire was used to collect sociodemographic data and item answers from 400 people with epilepsy (PWE) and without epilepsy caregivers on dependent variables: knowledge, attitudes, and practices towards epilepsy. Bivariate and logistic regression analyses were performed using IBM SPSS Statistics 21.0. Statistical significance was set when P value < 0.05. RESULTS The rates of poor knowledge, practices, and attitudes toward epilepsy were 11.5 %, 41 %, and 66.6 %, respectively. In the multivariate analysis, the risk of having poor knowledge about epilepsy was favored by lack of education (ORa = 4.31;CI95%:1.83-10.13;p = 0.001) and the absence of familiarity with epilepsy (ORa = 4.05;CI95%:1.92-8.54;p < 0.001). The risk of preferring allopathic practices to treat epilepsy was associated with lack of education (ORa = 2.21;CI95%:1.01-4.82;p = 0.046), residence in a city outside Casablanca (ORa = 2.33;CI95%:1.06-5.15;p = 0.035), age over 59 years (ORa = 2.50;CI95%:1.26-4.95; p = 0.008), residence in a rural areas (ORa = 4.41;CI95%:2.61-7.47;p < 0.001) and absence of familiarity with epilepsy (ORa = 4.08;CI95%:2.33-7.15;p < 0.001). Predictors of stigma towards epilepsy were female sex (ORa = 3.05;CI95%:2.04-4.56;p < 0.001) and the tendency to abandon anti-seizure medication for allopathic alternatives (ORa = 3.98;CI95%:2.21-7.17;p < 0.001), whereas advanced age was a protective factor (ORa = 0.57;CI95%:0.36-0.89;p = 0.014[39-59 years vs 18-29 years];ORa = 0.44;CI95%:0.23-0.82;p = 0.011[>59 years vs 18-29 years]). CONCLUSIONS The rate of poor attitudes and treatment-seeking behavior was high. This socio-cultural context certainly impacts the quality of life and care of Moroccan PWE. These results should be considered to raise awareness in the Moroccan population.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Nour El Imane Issam Salah
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurosurgery, IBN ROCHD University Hospital, Casablanca, Morocco
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Allen SE, Moyano LM, Wardle MT, Guzman C, Sanchez-Boluarte SS, Bonnet G, Bustos JA, O’Neal S, Garcia HH. Clinical Characteristics of Neurocysticercosis in a Peruvian Population-Based Epilepsy Cohort: A Descriptive Cross-Sectional Study of Baseline Clinical Intake. Pathogens 2023; 12:1313. [PMID: 38003778 PMCID: PMC10675766 DOI: 10.3390/pathogens12111313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population.
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Affiliation(s)
- Samantha E. Allen
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Luz M. Moyano
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
| | - Melissa T. Wardle
- Department of Epidemiology, Oregon Health and Science—Portland State University School of Public Health, Portland, OR 97236, USA;
| | - Carolina Guzman
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
| | | | - Gabrielle Bonnet
- Centre for the Mathematical Modeling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | - Javier A. Bustos
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
- Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima 02002, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Seth O’Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Department of Infectious Diseases, Oregon Health & Science University, Portland, OR 97236, USA
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes 24000, Peru; (L.M.M.); (J.A.B.); (S.O.); (H.H.G.)
- Instituto Nacional de Ciencias Neurologicas, Lima 02002, Peru; (C.G.); (S.S.S.-B.)
- Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima 02002, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA
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Punia V. Acute Symptomatic Seizures After Ischemic Strokes: Time Is Brain, Squared! Epilepsy Curr 2023; 23:345-347. [PMID: 38269345 PMCID: PMC10805089 DOI: 10.1177/15357597231197137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model Sinka L, Abraira L, Imbach LL, Zieglgänsberger D, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Bicciato G, Terziev R, Simmen C, Schubert KM, Elshahabi A, Baumann CR, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Bayona-Ortiz H, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Pinho E Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. JAMA Neurol . 2023;80(6):605-613. doi:10.1001/jamaneurol.2023.0611 . PMID: 37036702 ; PMCID: PMC10087089 Importance: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. Design, Setting, and Participants: This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures: Type of acute symptomatic seizure. Main Outcomes and Measures: All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and relevance: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of anti-seizure medication treatment and the methods and frequency of follow-up.
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Mugumbate R, Klevor R, Aguirre MO, Daniel GM, Yaqoob N, Acevedo K, Yewnetu E, Kanyabutembo C, Ibrahim EAA, Boutadghart S, Janneh A, Kissani N. Epilepsy awareness days, weeks, and months: Their roles in the fight against epilepsy and the intersectoral global action plan on epilepsy and other neurological disorders. Epilepsy Behav 2023; 148:109457. [PMID: 37839248 DOI: 10.1016/j.yebeh.2023.109457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES This research sought to find out the epilepsy awareness days around the world and understand the nature and role of the days in the fight against epilepsy in relation to the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders (2022-2031). METHODS We conducted a review of journal articles. The databases that we searched were ProQuest Central, EBSCOhost Academic Search Complete, EBSCO Medline, PubMed Central, Wiley Online, Directory of Open Access Journals (DOAJ), African Journals Online (AJOL), and Google Scholar. We limited our search to papers of relevance to our subject published between January 2000 and January 2023. We searched 'epilepsy awareness day, week, or month'. From the databases, 13 articles met our inclusion criteria. We augmented our results with a search on Google of articles about epilepsy awareness day, week, or month. We also searched directly on the websites of epilepsy organizations. RESULTS We found that epilepsy awareness days fall into these categories: global awareness days (n = 2), awareness months (n = 4), regional awareness weeks (n = 5), and regional awareness days (n = 1). Our search for national awareness days (n = 7) was not comprehensive, and this could be an area for future research. The literature shows that epilepsy awareness days could play a role in (1) reducing knowledge and treatment gaps, (2) increasing participation, (3) unlocking resources, and (4) necessitating policy change and increasing networking. The major role of these dedicated days in the IGAP is to accelerate awareness and advocacy for policy change and improved interventions. CONCLUSIONS Epilepsy awareness days are bringing stakeholders together already, and IGAP initiatives could tap into this achievement to accelerate awareness in a cost effective, contextual and collaborative manner. This could be achieved by adopting themes that relate more directly to the IGAP goals. Another important strategy is to motivate countries that do not have national epilepsy days or regions that do not have a regional awareness days, to consider doing one within the confines of resources.
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Affiliation(s)
- Rugare Mugumbate
- School of Health and Society, University of Wollongong, Australia; Department of Social Work & Community Development, University of Johannesburg, South Africa.
| | - Raymond Klevor
- Neuroscience Research Laboratory of Marrakesh Medical School, Cadi Ayyad University, Marrakesh, Morocco; Department of Neurology, Mohammed VI University Medical Center, Marrakesh, Morocco
| | | | - Gams Massi Daniel
- Neurology Unit, Douala General Hospital, Faculty of Health Sciences, University of Buea, Cameroon
| | - Nasir Yaqoob
- National Institute of Cardiovascular Diseases, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Keryma Acevedo
- Pontificia Universidad Católica de Chile Liga Chilena Contra la Epilepsia, Chile
| | | | | | - Etedal Ahmed A Ibrahim
- Faculty of Medicine, Alneelain University. The National Centre for Neurological Science, Khartoum, Sudan
| | - Salim Boutadghart
- Neuroscience Research Laboratory of Marrakesh Medical School, Cadi Ayyad University, Marrakesh, Morocco; Department of Neurology, Mohammed VI University Medical Center, Marrakesh, Morocco
| | - Adam Janneh
- Foundation for Epilepsy and Stigma Support (FESS-GAM), Gambia
| | - Najib Kissani
- Neuroscience Research Laboratory of Marrakesh Medical School, Cadi Ayyad University, Marrakesh, Morocco; Department of Neurology, Mohammed VI University Medical Center, Marrakesh, Morocco
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Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet 2023; 402:412-424. [PMID: 37459868 DOI: 10.1016/s0140-6736(23)01048-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/31/2023]
Abstract
Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany; Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Sui S, Sun J, Chen X, Fan F. Risk of Epilepsy Following Traumatic Brain Injury: A Systematic Review and Meta-analysis. J Head Trauma Rehabil 2023; 38:E289-E298. [PMID: 36730820 DOI: 10.1097/htr.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Limited evidence has explored the impact of traumatic brain injury (TBI) on posttraumatic epilepsy with control cohort for comparison. In addition, we could not find any review to identify the effect of TBI on the outcomes. Thus, we conducted this study to compare the risk of epilepsy between individuals with TBI and without TBI. METHODS Systematic and comprehensive search was carried out in the following databases and search engines: EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar from 1954 until January 2022. The Newcastle Ottawa (NO) Scale was utilized to assess the risk of bias. Meta-analysis was carried out using the random-effects model, and pooled odds ratio (OR) along with 95% CI was reported. RESULTS In total, we included 10 studies satisfying inclusion criteria. Most studies had good to satisfactory quality. The pooled OR was 4.25 (95% CI, 1.77-10.25; I2 = 100%), indicating that the individuals with TBI had 4.25 times higher risk of having epilepsy than individuals without TBI, and this association was statistically significant ( P = .001). Subgroup analysis based on the years of follow-up revealed that the patients within 5 years post-TBI had the highest risk of epilepsy (pooled OR = 7.27; 95% CI, 3.61-14.64). CONCLUSION Individuals with TBI had a significantly higher risk of epilepsy than the individuals without TBI, irrespective of the duration of the injury. Hence, long-term follow-up of the individuals with TBI is necessary to prevent any adverse consequences.
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Affiliation(s)
- Songtao Sui
- Departments of Neurosurgery (Messrs Sui and Chen) and Pharmacy (Ms Fan), Qingdao West Coast New Area Central Hospital, Qingdao, Shandong Province, China; and Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan City, Shandong Province, China (Mr Sun)
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Perucca E, Perucca P, White HS, Wirrell EC. Drug resistance in epilepsy. Lancet Neurol 2023:S1474-4422(23)00151-5. [PMID: 37352888 DOI: 10.1016/s1474-4422(23)00151-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023]
Abstract
Drug resistance is estimated to affect about a third of individuals with epilepsy, but its prevalence differs in relation to the epilepsy syndrome, the cause of epilepsy, and other factors such as age of seizure onset and presence of associated neurological deficits. Although drug-resistant epilepsy is not synonymous with unresponsiveness to any drug treatment, the probability of achieving seizure freedom on a newly tried medication decreases with increasing number of previously failed treatments. After two appropriately used antiseizure medications have failed to control seizures, individuals should be referred whenever possible to a comprehensive epilepsy centre for diagnostic re-evaluation and targeted management. The feasibility of epilepsy surgery and other treatments, including those targeting the cause of epilepsy, should be considered early after diagnosis. Substantial evidence indicates that a delay in identifying an effective treatment can adversely affect ultimate outcome and carry an increased risk of cognitive disability, other comorbidities, and premature mortality. Research on mechanisms of drug resistance and novel therapeutics is progressing rapidly, and potentially improved treatments, including those targeting disease modification, are on the horizon.
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Affiliation(s)
- Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Piero Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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11
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Owolabi MO, Leonardi M, Bassetti C, Jaarsma J, Hawrot T, Makanjuola AI, Dhamija RK, Feng W, Straub V, Camaradou J, Dodick DW, Sunna R, Menon B, Wright C, Lynch C, Chadha AS, Ferretti MT, Dé A, Catsman-Berrevoets CE, Gichu M, Tassorelli C, Oliver D, Paulus W, Mohammed RK, Charway-Felli A, Rostasy K, Feigin V, Craven A, Cunningham E, Galvin O, Perry AH, Fink EL, Baneke P, Helme A, Laurson-Doube J, Medina MT, Roa JD, Hogl B, O'Bryan A, Trenkwalder C, Wilmshurst J, Akinyemi RO, Yaria JO, Good DC, Hoemberg V, Boon P, Wiebe S, Cross JH, Haas M, Jabalpurwala I, Mojasevic M, DiLuca M, Barbarino P, Clarke S, Zuberi SM, Olowoyo P, Owolabi A, Oyesiku N, Maly-Sundgren PC, Norrving B, Soekadar SR, van Doorn PA, Lewis R, Solomon T, Servadei F. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19:371-383. [PMID: 37208496 PMCID: PMC10197060 DOI: 10.1038/s41582-023-00808-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- African Stroke Organization, Ibadan, Nigeria.
- World Federation for Neurorehabilitation, North Shields, UK.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Bassetti
- Neurology Department Inselspital - University of Bern, Bern, Switzerland
- European Academy of Neurology, Vienna, Austria
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- European Federation of Neurological Associations, Brussels, Belgium
| | | | | | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jennifer Camaradou
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- One Neurology Initiative, Brussels, Belgium
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
- American Brain Foundation, Minneapolis, MN, USA
| | - Rosita Sunna
- Tics and Tourette Across the Globe, Hannover, Germany
- Australian Clinical Psychology Association, Sydney, New South Wales, Australia
| | - Bindu Menon
- Department of Neurology, Apollo Specialty Hospitals, Nellore, India
| | | | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | | | | | - Anna Dé
- Women's Brain Project, Guntershausen, Switzerland
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- European Paediatric Neurology Society, Bolton, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Global Brain Health Institute, San Francisco, CA, USA
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences of the University of Pavia, Pavia, Italy
- IRCCS C. Mondino Foundation Neurological Institute, Pavia, Italy
- International Headache Society, London, UK
| | - David Oliver
- University of Kent, Canterbury, UK
- International Neuro-Palliative Care Society, Roseville, MN, USA
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians University Munich, Klinikum Großhadern, Munich, Germany
- International Federation of Clinical Neurophysiology, Milwaukee, WI, USA
| | - Ramla K Mohammed
- Amal Neuro Developmental Centres, Gudalur, India
- Al Ameen Educational Trust, Gudalur, India
| | | | - Kevin Rostasy
- European Paediatric Neurology Society, Bolton, UK
- Department of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Orla Galvin
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Ericka L Fink
- Department of Paediatric Neurology and Critical Care, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Marco T Medina
- National Autonomous University of Honduras, Tegucigalpa, Honduras
- Pan-American Federation of Neurological Societies, Santiago de Chile, Chile
| | - Juan David Roa
- HOMI Fundacion Hospital Paediatrico la Misericordia, Bogota, Colombia
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- World Sleep Society, Rochester, MN, USA
| | | | - Claudia Trenkwalder
- Paracelsus-Elena Hospital, Kassel, Department of Neurosurgery, University Medical Centre, Goettingen, Germany
| | - Jo Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- International Child Neurology Association, London, UK
| | - Rufus O Akinyemi
- African Stroke Organization, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph O Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - David C Good
- World Federation for Neurorehabilitation, North Shields, UK
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Volker Hoemberg
- World Federation for Neurorehabilitation, North Shields, UK
- SRH Neurorehabilitation Hospital Bad Wimpfen, Bad Wimpfen, Germany
| | - Paul Boon
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- International League Against Epilepsy, Flower Mound, TX, USA
| | - J Helen Cross
- International League Against Epilepsy, Flower Mound, TX, USA
- Clinical Neurosciences Section, UCL Institute of Child Health, University College London, London, UK
| | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, USA
| | | | | | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- European Brain Council, Brussels, Belgium
| | | | - Stephanie Clarke
- World Federation for Neurorehabilitation, North Shields, UK
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sameer M Zuberi
- European Paediatric Neurology Society, Bolton, UK
- Paediatric Neurosciences Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Nelson Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina, NC, USA
- World Federation of Neurosurgical Societies, Prague, Czech Republic
| | - Pia C Maly-Sundgren
- Department of Clinical Sciences/Diagnostic Radiology, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Peripheral Nerve Society, Roseville, MN, USA
| | - Richard Lewis
- Peripheral Nerve Society, Roseville, MN, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, North Yorkshire, UK
| | - Franco Servadei
- World Federation of Neurosurgical Societies, Prague, Czech Republic
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Milan, Italy
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12
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Jones GD, Kariuki SM, Ngugi AK, Mwesige AK, Masanja H, Owusu-Agyei S, Wagner R, Cross JH, Sander JW, Newton CR, Sen A. Development and validation of a diagnostic aid for convulsive epilepsy in sub-Saharan Africa: a retrospective case-control study. Lancet Digit Health 2023; 5:e185-e193. [PMID: 36963908 DOI: 10.1016/s2589-7500(22)00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 03/26/2023]
Abstract
BACKGROUND Identification of convulsive epilepsy in sub-Saharan Africa relies on access to resources that are often unavailable. Infrastructure and resource requirements can further complicate case verification. Using machine-learning techniques, we have developed and tested a region-specific questionnaire panel and predictive model to identify people who have had a convulsive seizure. These findings have been implemented into a free app for health-care workers in Kenya, Uganda, Ghana, Tanzania, and South Africa. METHODS In this retrospective case-control study, we used data from the Studies of the Epidemiology of Epilepsy in Demographic Sites in Kenya, Uganda, Ghana, Tanzania, and South Africa. We randomly split these individuals using a 7:3 ratio into a training dataset and a validation dataset. We used information gain and correlation-based feature selection to identify eight binary features to predict convulsive seizures. We then assessed several machine-learning algorithms to create a multivariate prediction model. We validated the best-performing model with the internal dataset and a prospectively collected external-validation dataset. We additionally evaluated a leave-one-site-out model (LOSO), in which the model was trained on data from all sites except one that, in turn, formed the validation dataset. We used these features to develop a questionnaire-based predictive panel that we implemented into a multilingual app (the Epilepsy Diagnostic Companion) for health-care workers in each geographical region. FINDINGS We analysed epilepsy-specific data from 4097 people, of whom 1985 (48·5%) had convulsive epilepsy, and 2112 were controls. From 170 clinical variables, we initially identified 20 candidate predictor features. Eight features were removed, six because of negligible information gain and two following review by a panel of qualified neurologists. Correlation-based feature selection identified eight variables that demonstrated predictive value; all were associated with an increased risk of an epileptic convulsion except one. The logistic regression, support vector, and naive Bayes models performed similarly, outperforming the decision-tree model. We chose the logistic regression model for its interpretability and implementability. The area under the receiver operator curve (AUC) was 0·92 (95% CI 0·91-0·94, sensitivity 85·0%, specificity 93·7%) in the internal-validation dataset and 0·95 (0·92-0·98, sensitivity 97·5%, specificity 82·4%) in the external-validation dataset. Similar results were observed for the LOSO model (AUC 0·94, 0·93-0·96, sensitivity 88·2%, specificity 95·3%). INTERPRETATION On the basis of these findings, we developed the Epilepsy Diagnostic Companion as a predictive model and app offering a validated culture-specific and region-specific solution to confirm the diagnosis of a convulsive epileptic seizure in people with suspected epilepsy. The questionnaire panel is simple and accessible for health-care workers without specialist knowledge to administer. This tool can be iteratively updated and could lead to earlier, more accurate diagnosis of seizures and improve care for people with epilepsy. FUNDING The Wellcome Trust, the UK National Institute of Health Research, and the Oxford NIHR Biomedical Research Centre.
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Affiliation(s)
- Gabriel Davis Jones
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; The Alan Turing Institute, London, UK
| | - Symon M Kariuki
- KEMRI and Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems, INDEPTH Network, Accra, Ghana
| | - Anthony K Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Centre for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - Angelina Kakooza Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Ryan Wagner
- MRC and Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Helen Cross
- Developmental Neurosciences, University College London NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Charles R Newton
- KEMRI and Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems, INDEPTH Network, Accra, Ghana; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
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13
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Li G, Wang M, Zheng M, Liu X, Yu T, Ren J, Wang Q. Causal effect of psychiatric disorders on epilepsy: A two-sample Mendelian randomization study. Brain Behav 2023; 13:e2939. [PMID: 36860142 PMCID: PMC10097067 DOI: 10.1002/brb3.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study aims to explore the relationship between psychiatric disorders and the risk of epilepsy using Mendelian randomization (MR) analysis. METHODS We collected summary statistics of seven psychiatric traits from recent largest genome-wide association study (GWAS), including major depressive disorder (MDD), anxiety disorder, autism spectrum disorder (ASD), bipolar disorder (BIP), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), and insomnia. Then, MR analysis estimates were performed based on International League Against Epilepsy (ILAE) consortium data (ncase = 15,212 and ncontrol = 29,677), the results of which were subsequently validated in FinnGen consortium (ncase = 6260 and ncontrol = 176,107). Finally, a meta-analysis was conducted based on the ILAE and FinnGen data. RESULTS We found significant causal effects of MDD and ADHD on epilepsy in the meta-analysis of the ILAE and FinnGen, with corresponding odds ratios (OR) of 1.20 (95% CI 1.08-1.34, p = .001) and 1.08 (95% CI 1.01-1.16, p = .020) by the inverse-variance weighted (IVW) method respectively. MDD increases the risk of focal epilepsy while ADHD has a risk effect on generalized epilepsy. No reliable evidence regarding causal effects of other psychiatric traits on epilepsy was identified. CONCLUSIONS This study suggests that major depressive disorder and attention deficit hyperactivity disorder may causally increase the risk of epilepsy.
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Affiliation(s)
- Gongfei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Minghui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meiqi Zheng
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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14
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Pesqueira GQ, San-Juan D, Albarrán RH, Vazquez ML, Canales GQ, Pesqueira JG. A systematic review of the epidemiology of epilepsy in Mexico during 1970 to 2020. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:74-80. [PMID: 36918010 PMCID: PMC10014193 DOI: 10.1055/s-0042-1758647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Epilepsy is the most common major neurological disorder that affects people of all ages. The prevalence varies from one country to another and even between different areas, due to a lack of access to medical care for reasons related to limited resources. OBJECTIVE Epilepsy is a worldwide public health problem that affects more deeply populations living in developing countries such as Mexico, where more aggressive health policies based on epidemiological data are needed; however, this information is scarce and the evolution of this data over time remains unclear. The aim of the present study is to provide an overview of the epidemiology of epilepsy in Mexico from 1970 to 2020. METHODS We searched descriptive epidemiological studies on epilepsy in rural and urban regions of Mexico from 1970 to 2020. Available data on the sociodemographic characteristics, prevalence, and incidence data were extracted. Finally, the abstract, full-text review, and data abstraction were conducted in duplicate and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Descriptive statistics was also used. RESULTS Overall, 11 underrepresented and heterogeneous epidemiological studies were included. In total, the prevalence of epilepsy in Mexico is 3.9 to 41:1,000 inhabitants; 3.9 to 41 per 1,000 persons in rural regions, and 3.49 to 44.3 per 1,000 persons in urban regions. None of these studies addressed the incidence of epilepsy. The prevalence of epilepsy in Mexico has remained unchanged during the last 5 decades. CONCLUSIONS Our results confirm a high prevalence of epilepsy in both urban and rural settings in Mexico that remain unchanged during the last 5 decades. All studies included in the present review showed multiple methodological limitations. New and robust epidemiological studies are needed to delineate the epidemiological profile of epilepsy in Mexico.
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Affiliation(s)
- Gerardo Quiñones Pesqueira
- National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Department of Neurophysiology, Mexico City, Mexico
| | - Daniel San-Juan
- National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Epilepsy Service, Mexico City, Mexico
| | - Rosana Huerta Albarrán
- Hospital General de México Dr Eduardo Liceaga, Department of Neuropediatrics, Mexico City, Mexico
| | - Maximo Leon Vazquez
- Insituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Department of Neuroscience, Mexico City, Mexico
| | - Gerardo Quiñones Canales
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Durango, Department of Neuroscience, Mexico
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15
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Nemathaga M, Maputle MS, Makhado L, Mashau NS. Diagnosis of Epilepsy by Traditional Healers and Its Implications on Management in the Selected Rural Communities of Limpopo and Mpumalanga Provinces: A Qualitative Study. Neuropsychiatr Dis Treat 2023; 19:973-983. [PMID: 37096026 PMCID: PMC10122469 DOI: 10.2147/ndt.s392479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/05/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction Epilepsy is a neurological disorder which causes seizures and may be accompanied by loss of unconsciousness and control of bowel or bladder function. However, other types of epilepsy are only characterised by rapid blinking or a few seconds of staring into space. Many people living with epilepsy in rural communities consult traditional healers as their first line of treatment for epilepsy. Second preference is given to medical practitioners which causes unnecessary delay in the early diagnosis and treatment of epilepsy. This study aimed to explore how traditional healers diagnose epilepsy and its implications on management in the selected rural communities of Limpopo and Mpumalanga Provinces. Methods A qualitative approach using explorative, descriptive and contextual designs was adopted. Purposive sampling was used to sample six villages in Limpopo and Mpumalanga Provinces. Snowball sampling was used to sample twenty traditional healers. Data were collected through in-depth individual interviews at the participant's homes. Data were analysed using Tesch's eight steps of open coding data analysis. Results This study found that traditional healers have varied beliefs and misconceptions regarding the causes and diagnosis of epilepsy, hence this greatly influencing the management. The misconceptions on the causes include a calling by ancestors, urine contents, snake in the stomach, contaminated digestive system and witchcraft. The management included using herbal plants, insects, foam excreted during seizures and urine of the person living with epilepsy. Recommendation It is recommended that for effective management of epilepsy, there should be coordination between traditional healing and western medicine. Future research should look at the integration of traditional medicine and western medicine.
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Affiliation(s)
- Muofheni Nemathaga
- Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa
| | - Maria S Maputle
- Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa
- Correspondence: Maria S Maputle, Email
| | - Lufuno Makhado
- Department of Public Health, University of Venda, Thohoyandou, South Africa
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16
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Camacho-Caballero K, Malaga M, Peixoto de Barcelos I, Prentice AF, Berkowitz AL. A 47-Year-Old Man Presenting With Seizures and Prior Stroke. Neurohospitalist 2023; 13:74-77. [PMID: 36531844 PMCID: PMC9755623 DOI: 10.1177/19418744221122877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
A 47-year-old man presented to his local hospital in Peru after a generalized tonic-clonic seizure. His family reported a history of prior stroke of unclear etiology. This case report discusses the approach to a first seizure (including in tropical regions like Peru), the relationship between stroke and seizures, the approach to stroke in the young, and how to diagnose rare diseases in resource-limited settings.
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Affiliation(s)
- Kiara Camacho-Caballero
- Facultad de Ciencias de la Salud, CHANGE Research Working Group Lima, Universidad Científica del Sur, Lima, Perú
- Grupo Estudiantil de Investigación en Neurociencias, SOCIEM-USMP, Lima, Perú
| | - Marco Malaga
- Grupo Estudiantil de Investigación en Neurociencias, SOCIEM-USMP, Lima, Perú
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú
| | - Isabella Peixoto de Barcelos
- Center for Applied Genomics, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
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17
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Detopoulou P, Papadopoulou SK, Voulgaridou G, Dedes V, Tsoumana D, Gioxari A, Gerostergios G, Detopoulou M, Panoutsopoulos GI. Ketogenic Diet and Vitamin D Metabolism: A Review of Evidence. Metabolites 2022; 12:metabo12121288. [PMID: 36557329 PMCID: PMC9788458 DOI: 10.3390/metabo12121288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The ketogenic diet (KD), which is low in carbohydrates and high to normal in fat and protein, has been traditionally used in epilepsy for the last 100 years. More recently, its application in obesity has been introduced. The present review aimed to investigate the effects of the KD on vitamin D. In total, five studies were done in healthy adults, one in subjects with type 2 diabetes, and seven in subjects with epilepsy that assessed the levels of vitamin D pre- and post-intervention. In the majority of studies, increases in circulating vitamin D were reported. The relationship of the KD with vitamin D was explained through several mechanisms: ketone bodies, macronutrient intake, the status levels of other fat-soluble vitamins, weight loss, changes in the hormonal milieu, and effects on gut microbiota. Moreover, potential nutrient-gene-related interactions were discussed. There is still a need to conduct multiple arm studies to compare the effects of the KD versus other diets and better decipher the particular effects of the KD on vitamin D levels and metabolism. Moreover, differentiations of the diet's effects according to sex and genetic makeup should be investigated to prescribe KDs on a more personalized basis.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, 11526 Athens, Greece
- Correspondence:
| | - Sousana K. Papadopoulou
- Department of Nutritional Science and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Science and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Vasileios Dedes
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, 24100 Kalamata, Greece
| | - Despoina Tsoumana
- Department of Nutritional Science and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Aristea Gioxari
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, 24100 Kalamata, Greece
| | - George Gerostergios
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, 11526 Athens, Greece
| | - Maria Detopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
| | - George I. Panoutsopoulos
- Department of Nutritional Science and Dietetics, Faculty of Health Sciences, University of Peloponnese, 24100 Kalamata, Greece
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18
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Pharmacotherapeutic potential of walnut (Juglans spp.) in age-related neurological disorders. IBRO Neurosci Rep 2022; 14:1-20. [PMID: 36507190 PMCID: PMC9727645 DOI: 10.1016/j.ibneur.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Global and regional trends of population aging spotlight major public health concerns. As one of the most common adverse prognostic factors, advanced age is associated with a remarkable incidence risk of many non-communicable diseases, affecting major organ systems of the human body. Age-dependent factors and molecular processes can change the nervous system's normal function and lead to neurodegenerative disorders. Oxidative stress results from of a shift toward reactive oxygen species (ROS) production in the equilibrium between ROS generation and the antioxidant defense system. Oxidative stress and neuroinflammation caused by Amyloid-ß protein deposition in the human brain are the most likely pathogenesis of Alzheimer's disease (AD). Walnut extracts could reduce Amyloid-ß fibrillation and aggregation, indicating their beneficial effects on memory and cognition. Walnut can also improve movement disabilities in Parkinson's disease due to their antioxidant and neuroprotective effect by reducing ROS and nitric oxide (NO) generation and suppressing oxidative stress. It is noteworthy that Walnut compounds have potential antiproliferative effects on Glioblastoma (the most aggressive primary cerebral neoplasm). This effective therapeutic agent can stimulate apoptosis of glioma cells in response to oxidative stress, concurrent with preventing angiogenesis and migration of tumor cells, improving the quality of life and life expectancy of patients with glioblastoma. Antioxidant Phenolic compounds of the Walnut kernel could explain the significant anti-convulsion ability of Walnut to provide good prevention and treatment for epileptic seizures. Moreover, the anti-inflammatory effect of Walnut oil could be beneficial in treating multiple sclerosis. In this study, we review the pharmaceutical properties of Walnut in age-related neurological disorders.
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19
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Aerospace Medicine Clinic. Aerosp Med Hum Perform 2022; 93:824-827. [DOI: 10.3357/amhp.6145.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Sailike B, Omarova Z, Jenis J, Adilbayev A, Akbay B, Askarova S, Jin WL, Tokay T. Neuroprotective and anti-epileptic potentials of genus Artemisia L. Front Pharmacol 2022; 13:1021501. [DOI: 10.3389/fphar.2022.1021501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
The Genus Artemisia L. is one of the largest genera in the Asteraceae family growing wild over in Europe, North America, and Central Asia and has been widely used in folk medicine for the treatment of various ailments. Phytochemical and psychopharmacological studies indicated that the genus Artemisia extracts contain various antioxidant and anti-inflammatory compounds and possess antioxidant, anti-inflammatory, antimicrobial, antimalarial, and antitumor activity. Recently, increasing experimental studies demonstrated that many Artemisia extracts offer a great antiepileptic potential, which was attributed to their bioactive components via various mechanisms of action. However, detailed literature on the antiepileptic properties of the genus Artemisia and its mechanism of action is segregated. In this review, we tried to gather the detailed neuroprotective and antiepileptic properties of the genus Artemisia and its possible underlying mechanisms. In this respect, 63 articles were identified in the PubMed and Google scholars databases, from which 18 studies were examined based on the pharmacological use of the genus Artemisia species in epilepsy. The genus Artemisia extracts have been reported to possess antioxidant, anti-inflammatory, neurotransmitter-modulating, anti-apoptotic, anticonvulsant, and pro-cognitive properties by modulating oxidative stress caused by mitochondrial ROS production and an imbalance of antioxidant enzymes, by protecting mitochondrial membrane potential required for ATP production, by upregulating GABA-A receptor and nACh receptor activities, and by interfering with various anti-inflammatory and anti-apoptotic signaling pathways, such as mitochondrial apoptosis pathway, ERK/CREB/Bcl-2 pathway and Nrf2 pathway. This review provides detailed information about some species of the genus Artemisia as potential antiepileptic agents. Hence, we recommend further investigations on the purification and identification of the most biological effective compounds of Artemisia and the mechanisms of their action to cure epilepsy and other neurological diseases.
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Patel AA, Birbeck GL, Mazumdar M, Mwanza S, Nyirongo R, Berejena D, Kasolo J, Mwale T, Nambeye V, Nkole KL, Kawatu N, Zhang B, Rotenberg A. Identifying biomarkers for epilepsy after cerebral malaria in Zambian children: rationale and design of a prospective observational study. BMJ Open 2022; 12:e062948. [PMID: 35851014 PMCID: PMC9297226 DOI: 10.1136/bmjopen-2022-062948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Malaria affecting the central nervous system (CM) is a major contributor to paediatric epilepsy in resource-poor settings, with 10%-16% of survivors developing epilepsy within 2 years of infection. Despite high risk for post-malaria epilepsy (PME), biomarkers indicating which CM survivors will develop epilepsy are absent. Such biomarkers are essential to identify those at highest risk who might benefit most from close surveillance and/or preventive treatments. Electroencephalography (EEG) contains signals (specifically gamma frequency activity), which are correlated with higher risk of PME and provide a biomarker for the development of epilepsy. We propose to study the sensitivity of quantitative and qualitative EEG metrics in predicting PME, and the potential increased sensitivity of this measure with additional clinical metrics. Our goal is to develop a predictive PME index composed of EEG and clinical history metrics that are highly feasible to obtain in low-resourced regions. METHODS AND ANALYSES This prospective observational study being conducted in Eastern Zambia will recruit 250 children aged 6 months to 11 years presenting with acute CM and follow them for two years. Children with pre-existing epilepsy diagnoses will be excluded. Outcome measures will include qualitative and quantitative analysis of routine EEG recordings, as well as clinical metrics in the acute and subacute period, including histidine-rich protein 2 levels of parasite burden, depth and length of coma, presence and severity of acute seizures, presence of hypoglycaemia, maximum temperature and 1-month post-CM neurodevelopmental assessment scores. We will test the performance of these EEG and clinical metrics in predicting development of epilepsy through multivariate logistic regression analyses. ETHICS AND DISSEMINATION This study has been approved by the Boston Children's Hospital Institutional Review Board, University of Zambia Biomedical Research Ethics Committee, and National Health Research Authority of Zambia. Results will be disseminated locally in Zambia followed by publication in international, open access, peer-reviewed journals when feasible.
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Affiliation(s)
- Archana A Patel
- Neurology, Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gretchen L Birbeck
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
- Epilepsy Division, University of Rochester Department of Neurology, Rochester, New York, USA
| | - Maitreyi Mazumdar
- Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | - Joseph Kasolo
- Paediatrics, Chipata Central Hospital, Chipata, Zambia
| | - Tina Mwale
- Paediatrics, Chipata Central Hospital, Chipata, Zambia
| | | | | | - Nfwama Kawatu
- University Teaching Hospitals- Children's Hospital, Lusaka, Zambia
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Rotenberg
- Neurology, Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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22
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Cicek E, Sanlier N. The place of a ketogenic diet in the treatment of resistant epilepsy: a comprehensive review. Nutr Neurosci 2022:1-14. [PMID: 35791085 DOI: 10.1080/1028415x.2022.2095819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The ketogenic diet (KD) is a high-fat, adequate-protein, and low-carb diet. Ketone bodies increase in the blood due to low carbohydrate content and high-fat content in the diet. The most important feature of the ketogenic diet is that it causes the production of ketone bodies in the liver. Ketone bodies are an alternative fuel to glucose for the brain and form the structure necessary for the cell membrane and biosynthesis of triglycerides. The ketogenic diet provides evidence on seizure control with anticonvulsant effects. In this review, the positive/negative effects of KD on seizure control, place, importance, quality of life, cognition, and behavior in the treatment of resistant epilepsy were examined.Methods: Scientific information on the subject was obtained from the literature accessed through databases such as MEDLINE, Embase, Web of Science, Cochrane Central, www.ClinicalTrials.gov, PubMed, Science Direct, and Google Scholar.Results: Although it has started to be used as a treatment method in many diseases today, the main area of effect of KD is drug-resistant epilepsy. In order for the ketogenic diet to be successful in these patients, it is necessary to choose the appropriate patient, medical treatment and diet plan, inform the patient sufficiently, and perform frequent monitoring in accordance with the follow-up criteria. It is argued that KD is one of the most effective treatments for epilepsy.Conclusion: The fact that KDs generally have a restricted diet pattern, the need for supplementation, biochemical findings and possible side effects raise the issue of diet sustainability. More clinical studies are needed to generalize.
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Affiliation(s)
- Ebru Cicek
- Ankara Medipol University, School of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Nevin Sanlier
- Ankara Medipol University, School of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
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23
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Yu T, Huo L, Lei J, Sun JJ, Wang H. Modulation of Microglia M2 Polarization and Alleviation of Hippocampal Neuron Injury By MiR-106b-5p/RGMa in a Mouse Model of Status Epilepticus. Inflammation 2022; 45:2223-2242. [PMID: 35789312 DOI: 10.1007/s10753-022-01686-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
MicroRNAs (miRNAs) regulate gene expression at the post-transcriptional level. The miRNA miR-106b-5p has been linked to epilepsy, but its specific role and mechanism of action remain unclear. This was investigated in the present study using a mouse model of pilocarpine-induced status epilepticus and an in vitro system of HT22 hippocampal cells treated with Mg2+-free solution and cocultured with BV2 microglia cells. We found that inhibiting miR-106b-5p expression promoted microglia M2 polarization, reduced the inflammatory response, and alleviated neuronal injury. These effects involved modulation of the repulsive guidance molecule A (RGMa)-Rac1-c-Jun N-terminal kinase (JNK)/p38-mitogen-activated protein kinase (MAPK) signaling axis. Our results suggest that therapeutic strategies targeting miR-106b-5p or downstream factors can be effective in preventing epileptogenesis or treating epilepsy.
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Affiliation(s)
- Tao Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang City, 110004, China
| | - Liang Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang City, 110004, China
| | - Jie Lei
- Department of Pediatrics, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang City, 110004, China
| | - Jing-Jing Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang City, 110004, China
| | - Hua Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang City, 110004, China.
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24
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Wang Z, Garcia RM, Huff HV, Niquen-Jimenez M, Marcos LA, Lam SK. Neurocysticercosis control for primary epilepsy prevention: a systematic review. Pathog Glob Health 2022; 116:282-296. [PMID: 34928183 PMCID: PMC9248947 DOI: 10.1080/20477724.2021.2015869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Neurocysticercosis (NCC) is a leading cause of preventable epilepsy in lower- and upper- middle-income countries (LMICs/UMICs). NCC is a human-to-human transmitted disease caused by ingestion of Taenia solium eggs from a Taenia carrier. T. solium infection control is the key to reduce NCC incidence. This systematic review aims to identify T. solium control programs that can provide frameworks for endemic areas to prevent NCC-related epilepsy. A systematic search was conducted in PubMed/Medline, Embase, Web of Science, and Cochrane Library databases in March 2021. After title and abstract review, full texts were screened for qualitative analysis. Additional articles were identified via citation search. Of 1322 total results, 34 unique studies were included. Six major intervention types were identified: national policy (8.8%), community sanitation improvement (8.8%), health education (8.8%), mass drug administration (29.4%), pig vaccination and treatment (32.4%), and combined human and pig treatment (11.8%). Overall, 28 (82.4%) studies reported decreased cysticercosis prevalence following the intervention. Only health education and combined human and pig treatment were effective in all selected studies. NCC causes preventable epilepsy in LMICs/UMICs and its incidence can be reduced through T. solium control. Most interventions that disrupt the T. solium transmission cycle are effective. Long-term sustained results require comprehensive programs, ongoing surveillance, and collaborative effort among multisectoral agencies.
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Affiliation(s)
- Zhe Wang
- Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Division of Infectious Diseases, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Department of Microbiology and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,CONTACT Zhe Wang Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, HSC T12 Rm 080, 100 Nicolls Rd, Stony Brook, NY11790, USA
| | - Roxanna M. Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hanalise V. Huff
- Fogarty Fellow, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Milagros Niquen-Jimenez
- Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis A. Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA,Department of Microbiology and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sandi K. Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
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25
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He C, Chen C, Yang Y, Hu L, Jin B, Ming W, Wang Z, Ding Y, Ding M, Wang S, Wang S. Clinical Characteristics and Prognostic Significance of Subclinical Seizures in Focal Epilepsy: A Retrospective Study. Neurol Ther 2022; 11:763-779. [PMID: 35378679 PMCID: PMC9095772 DOI: 10.1007/s40120-022-00342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim was to evaluate the clinical characteristics and prognostic significance of subclinical seizures (SCSs) on scalp video-electroencephalogram (VEEG) monitoring with or without intracranial electroencephalogram (IEEG) monitoring in patients who had epilepsy surgery. METHODS We reviewed 286 epileptic patients who underwent subsequent epilepsy surgery during scalp-VEEG evaluation with or without IEEG monitoring between 2013 and 2020, with a minimum follow-up of 1 year. The prevalence and clinical characteristics of SCSs, as well as their prognostic significance, were analyzed. RESULTS A total of 286 patients were enrolled for analysis, and 80 patients had IEEG implanted. SCSs were recorded in 9.79% of the patients based on VEEG and 50% based on IEEG. In the VEEG group (n = 286), younger seizure onset (P = 0.004) was associated with the presence of s-SCSs (SCSs detected on scalp VEEG). In the IEEG group (n = 80), temporal lobe epilepsy (P = 0.015) was associated with the presence of i-SCSs (SCSs detected on IEEG). Of 286 patients, 208 (72.73%) were seizure-free in the VEEG group, and 56 0f 80 patients (70%) were seizure-free in the IEEG group through the last follow-up. In the VEEG group, the presence of s-SCSs did not affect seizure outcome; predictors of seizure recurrence were longer epilepsy duration (P = 0.003, OR 1.003, 95% CI 1.001-1.005), history of focal to bilateral tonic-clonic seizure (P = 0.027, OR 1.665, 95% CI 1.060-2.613), nonspecific pathology (P = 0.018, OR 2.184, 95% CI 1.145-4.163), and incomplete resection (P = 0.004, OR 2.705, 95% CI 1.372-5.332). In the IEEG group, i-SCSs were significantly associated with seizure outcome (P = 0.028, OR 0.371, 95% CI 0.153-0.898). CONCLUSION The rate of SCSs captured on IEEG monitoring was higher than that on VEEG monitoring during presurgical evaluation. SCSs detected on VEEG monitoring were associated with younger seizure onset. SCSs detected on IEEG monitoring were associated with temporal lobe epilepsy and also predicted surgical outcomes in focal epilepsy.
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Affiliation(s)
- Chenmin He
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Cong Chen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Yuyu Yang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Lingli Hu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wenjie Ming
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Zhongjin Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
| | - Shan Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
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Punia V, Ellison L, Bena J, Chandan P, Sivaraju A, George P, Newey CR, Hantus S. Acute epileptiform abnormalities are the primary predictors of post-stroke epilepsy: a matched, case-control study. Ann Clin Transl Neurol 2022; 9:558-563. [PMID: 35243824 PMCID: PMC8994977 DOI: 10.1002/acn3.51534] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke patients who underwent continuous EEG (cEEG) monitoring within 7 days of presentation and developed post-stroke epilepsy (PSE; cases, n = 36) were matched (1:2 ratio) by age and follow-up duration with ones who did not (controls, n = 72). Variables significant on univariable analysis [hypertension, smoking, hemorrhagic conversion, pre-cEEG convulsive seizures, and epileptiform abnormalities (EAs)] were included in the multivariable logistic model and only the presence of EAs on EEG remained significant PSE predictor [OR = 11.9 (1.75-491.6)]. With acute EAs independently predicting PSE development, accounting for their presence may help to tailor post-acute symptomatic seizure management and aid anti-epileptogenesis therapy trials.
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Affiliation(s)
- Vineet Punia
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lisa Ellison
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jim Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pradeep Chandan
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adithya Sivaraju
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Pravin George
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher R Newey
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Hantus
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Espino P, Couper R, Burneo J. An update on Neurocysticercosis-related epilepsy. Clin Neurol Neurosurg 2022; 213:107139. [DOI: 10.1016/j.clineuro.2022.107139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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28
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Punia V. Go Ahead! Use that Reperfusion Treatment, don’t Worry About Subsequent Seizures! Epilepsy Curr 2022; 22:105-107. [PMID: 35444510 PMCID: PMC8988720 DOI: 10.1177/15357597221076227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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29
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Zhu H, Bi D, Zhang Y, Kong C, Du J, Wu X, Wei Q, Qin H. Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. Signal Transduct Target Ther 2022; 7:11. [PMID: 35034957 PMCID: PMC8761750 DOI: 10.1038/s41392-021-00831-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023] Open
Abstract
The ketogenic diet (KD) is a high-fat, adequate-protein, and very-low-carbohydrate diet regimen that mimics the metabolism of the fasting state to induce the production of ketone bodies. The KD has long been established as a remarkably successful dietary approach for the treatment of intractable epilepsy and has increasingly garnered research attention rapidly in the past decade, subject to emerging evidence of the promising therapeutic potential of the KD for various diseases, besides epilepsy, from obesity to malignancies. In this review, we summarize the experimental and/or clinical evidence of the efficacy and safety of the KD in different diseases, and discuss the possible mechanisms of action based on recent advances in understanding the influence of the KD at the cellular and molecular levels. We emphasize that the KD may function through multiple mechanisms, which remain to be further elucidated. The challenges and future directions for the clinical implementation of the KD in the treatment of a spectrum of diseases have been discussed. We suggest that, with encouraging evidence of therapeutic effects and increasing insights into the mechanisms of action, randomized controlled trials should be conducted to elucidate a foundation for the clinical use of the KD.
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Affiliation(s)
- Huiyuan Zhu
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Youhua Zhang
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng Kong
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiahao Du
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Xiawei Wu
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
- Shanghai Clinical College, Anhui Medical University, Hefei, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Huanlong Qin
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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30
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Kwon CS, Wagner RG, Carpio A, Jetté N, Newton CR, Thurman DJ. The worldwide epilepsy treatment gap: A systematic review and recommendations for revised definitions - A report from the ILAE Epidemiology Commission. Epilepsia 2022; 63:551-564. [PMID: 35001365 DOI: 10.1111/epi.17112] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In order to more appropriately apply and understand the "epilepsy treatment gap" (ETG) concept in current health systems, revised conceptual and operational definitions of ETG are timely and necessary. This article therefore systematically reviews worldwide studies of the ETG, distinguishing high-, middle-, and low-income regions, and provides recommendations for an updated International League Against Epilepsy (ILAE) definition of ETG. METHODS A systematic review of the ETG was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was conducted from January 1990 to July 2019, in the online databases of Ovid MEDLINE and Embase. Identified abstracts were reviewed in duplicate and data independently extracted using a standard proforma. Data describing treatment gap information including both diagnostic and therapeutic aspects of access to epilepsy treatment were recorded. Descriptive statistics are presented. RESULTS The treatment gap reported in the 45 distinctive populations represented 33 countries. Treatment gap definitions varied widely. The reported ETGs ranged broadly from 5.6% in Norway to 100% in parts of Tibet, Togo, and Uganda. The wide range of reported ETGs was multifactorial in origin including true differences in the availability and utilization of health care among study populations, variations in operational definitions of the epilepsy treatment gap, and methodological differences in sampling and identifying representative epilepsy cases in populations. Significance and recommendations For the ETG to be a useful metric to compare levels of unmet epilepsy care across different countries and regions, a standardized definition must be adapted, recognizing some of the limitations of the current definitions. Our proposed definition takes into account the lack of effective health care insurance, the diagnostic gap, the therapeutic gap, quality-of-care, and other unmet health care needs."
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Affiliation(s)
- Churl-Su Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Agincourt Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Arturo Carpio
- Research Institute, University of Cuenca School of Medicine, Cuenca, Ecuador
| | - Nathalie Jetté
- Department of Neurology, Icahn school of Medicine at Mount Sinai, New York, New York, USA
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31
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Wei W, Yang R, Zhang J, Chen H, Ye J, Su Q, Liao J, Xiao Z. The Mediating Roles of Family Resilience and Social Support in the Relationship Between Illness Severity and Depressive Symptoms Among Primary Caregivers of Children With Epilepsy in China. Front Neurol 2022; 13:831899. [PMID: 35265030 PMCID: PMC8899194 DOI: 10.3389/fneur.2022.831899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study was designed to assess the effects of epilepsy severity, family resilience, and social support on depression in primary caregivers of children with epilepsy (CWE), and to test the mediating roles of family resilience and social support in this relationship. METHOD Two hundred fifty-two caregivers of children with epilepsy were recruited from October 2020 to May 2021. The questionnaire contained sociodemographic characteristics, Epilepsy Severity, Chinese-Family Resilience Assessment Scale (C-FRAS), Social Support Rating Scale (SSRS), Beck Depression Inventory (BDI). Structural equation models were used to evaluate whether family resilience and social support as mediators between epilepsy severity and depression. RESULTS In this study, the prevalence of depressive symptoms among primary caregivers of CWE in China was 69.84%. Epilepsy severity was positively associated with depression. Family resilience and social support were negatively correlated with depressive symptoms (both p < 0.01). Furthermore, the fitness indices of structural models were satisfactory. The direct effect of epilepsy severity on depression was 0.266 (95% CI 0.064-0.458), this pathway explained 62.88% variance of depression. The indirect effect of family resilience and then social support was 0.069 (95% CI 0.025-0.176), indicating that the serial multiple mediation was significant. The serial mediation pathway explained 16.31% variance of depression. CONCLUSIONS The high incidence of depression among primary carers of CWE deserves more attention. They should be screened routinely, especially those parents of children with severe epilepsy. Family resilience and social support could be protective factors for caregivers' mental adjustment. Therefore, future psychosocial interventions for enhancing family resilience and social support should be implemented, in order to reduce their depression.
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Affiliation(s)
- Wenjing Wei
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Rongrong Yang
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Jie Zhang
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Haili Chen
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Jinghua Ye
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
- *Correspondence: Jianxiang Liao
| | - Zhitian Xiao
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
- Zhitian Xiao
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32
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Samia P, Naanyu V, Cross JH, Idro R, Boon P, Wilmshurst J, Luchters S. Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya. Epilepsy Behav 2021; 125:108362. [PMID: 34740092 DOI: 10.1016/j.yebeh.2021.108362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa. OBJECTIVES This study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. METHODS This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians. RESULTS This study enrolled 17 participants including 14 caregivers of children aged 1-17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy. CONCLUSIONS Among participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Kenya; Department of Public Health and Primary Care, Ghent University, Belgium.
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Kenya; AMPATH Research, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Institute of Neurosciences, University of Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Belgium; Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Australia
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33
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Gala D, Gurusamy V, Patel K, Damodar S, Swaminath G, Ullal G. Stem Cell Therapy for Post-Traumatic Stress Disorder: A Novel Therapeutic Approach. Diseases 2021; 9:diseases9040077. [PMID: 34842629 PMCID: PMC8628773 DOI: 10.3390/diseases9040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
Stem cell therapy is a rapidly evolving field of regenerative medicine being employed for the management of various central nervous system disorders. The ability to self-renew, differentiate into specialized cells, and integrate into neuronal networks has positioned stem cells as an ideal mechanism for the treatment of epilepsy. Epilepsy is characterized by repetitive seizures caused by imbalance in the GABA and glutamate neurotransmission following neuronal damage. Stem cells provide benefit by reducing the glutamate excitotoxicity and strengthening the GABAergic inter-neuron connections. Similar to the abnormal neuroanatomic location in epilepsy, post-traumatic stress disorder (PTSD) is caused by hyperarousal in the amygdala and decreased activity of the hippocampus and medial prefrontal cortex. Thus, stem cells could be used to modulate neuronal interconnectivity. In this review, we provide a rationale for the use of stem cell therapy in the treatment of PTSD.
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34
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Perez-Malagon CD, Lopez-Gonzalez MA. Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus. Cureus 2021; 13:e18199. [PMID: 34584817 PMCID: PMC8458162 DOI: 10.7759/cureus.18199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Presently, at least 60 million people are suffering from epilepsy worldwide. Although multiple pharmacological options for treatment exist, about 30% to 40% of these patients are estimated to have drug-resistant epilepsy (DRE), which is associated with severe disability and morbidity. The surgical treatment options are restricted to either open surgical procedures or laser ablations. When a resective option is not favorable, then neuromodulation options such as vagal nerve stimulation and deep brain stimulation are considered. A relatively recent and more commonly used clinical application is the deep brain stimulation (DBS) of the anterior thalamic nucleus, FDA approval for which was obtained in 2018. Furthermore, new technological advances in DBS technology are expected to positively impact the treatment options of these patients.
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Affiliation(s)
- Carlos D Perez-Malagon
- Anatomy, Centro de Ciencias Biomedicas, Universidad Autonoma de Aguascalientes, Aguascalientes, MEX
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35
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Jiménez-Villegas MJ, Lozano-García L, Carrizosa-Moog J. Update on first unprovoked seizure in children and adults: A narrative review. Seizure 2021; 90:28-33. [DOI: 10.1016/j.seizure.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 01/11/2023] Open
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36
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Jahanbani R, Bahramnejad E, Rahimi N, Shafaroodi H, Sheibani N, Moosavi-Movahedi AA, Dehpour AR, Vahdati K. Anti-seizure effects of walnut peptides in mouse models of induced seizure: The involvement of GABA and nitric oxide pathways. Epilepsy Res 2021; 176:106727. [PMID: 34333374 DOI: 10.1016/j.eplepsyres.2021.106727] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022]
Abstract
Epilepsy is one of the foremost medical disorders. Oxidative stress is a well-known mechanism in epileptogenesis, and many studies suggest that oxidative stress affects the onset and evolution of epilepsy. Here we evaluated the walnut peptide extracts' anti-seizure property in three different mouse seizure models including pentylenetetrazole-induced clonic seizure, chemical kindling, and maximal electroshock. Walnut peptides (20 mg/Kg) were administered by intraperitoneal (IP) injection of mice 60 min before seizure induction in the three models. To delineate the mechanisms of walnut peptides anti-seizure activity, we evaluated the impact of diazepam, flumazenil, and a NOS inhibitor on this activity. Intraperitoneal administration of walnut peptides significantly increased the seizure threshold. Our results also demonstrated that walnut peptides exert their anti-seizure properties through the modulation of benzodiazepine receptors. Thus, walnut peptides may be considered as a new anti-convulsion agent, which can reduce seizure occurrence and slow down seizure progression.
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Affiliation(s)
- Raheleh Jahanbani
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Bahramnejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Rahimi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Shafaroodi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Sheibani
- Departments of Ophthalmology and Visual Sciences, Cell and Regenerative Biology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ali Akbar Moosavi-Movahedi
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; UNESCO Chair on Interdisciplinary Research in Diabetes, University of Tehran, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kourosh Vahdati
- Department of Horticulture, College of Aburaihan, University of Tehran, Tehran, Iran.
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37
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Shellhaas RA, Wusthoff CJ, Numis AL, Chu CJ, Massey SL, Abend NS, Soul JS, Chang T, Lemmon ME, Thomas C, McNamara NA, Guillet R, Franck LS, Sturza J, McCulloch CE, Glass HC. Early-life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study. Epilepsia 2021; 62:1871-1882. [PMID: 34212365 DOI: 10.1111/epi.16978] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to evaluate early-life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. METHODS Neonates with acute symptomatic seizures born 7/2015-3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One-hour EEG was recorded at age three months. Post-neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills - WIDEA-FS) were assessed. Cox regression was used to assess epilepsy-free survival. RESULTS Among 282 infants, 37 (13%) had post-neonatal epilepsy by 24-months [median age of onset 7-months (IQR 3-14)]. Among those with post-neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug-resistant epilepsy. Most children with post-neonatal epilepsy had abnormal neurodevelopment at 24-months (WIDEA-FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6-17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9-5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4-5.9). In an adjusted model, days of neonatal EEG-confirmed seizures (HR 1.4 per day, 95% CI 1.2-1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9-7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three-month EEG was not associated with epilepsy. SIGNIFICANCE In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post-neonatal epilepsy by age 24-months. However, there was a high risk of severe neurodevelopmental impairment and drug-resistant seizures among children with post-neonatal epilepsy. Days of EEG-confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow-up planning, and future research to prevent post-neonatal epilepsy.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Courtney J Wusthoff
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA, USA.,Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Adam L Numis
- Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shavonne L Massey
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas S Abend
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Departments of Anesthesia & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Taeun Chang
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Monica E Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nancy A McNamara
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA
| | - Linda S Franck
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Hannah C Glass
- Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
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38
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Rincon N, Barr D, Velez-Ruiz N. Neuromodulation in Drug Resistant Epilepsy. Aging Dis 2021; 12:1070-1080. [PMID: 34221550 PMCID: PMC8219496 DOI: 10.14336/ad.2021.0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/11/2021] [Indexed: 12/26/2022] Open
Abstract
Epilepsy affects approximately 70 million people worldwide, and it is a significant contributor to the global burden of neurological disorders. Despite the advent of new AEDs, drug resistant-epilepsy continues to affect 30-40% of PWE. Once identified as having drug-resistant epilepsy, these patients should be referred to a comprehensive epilepsy center for evaluation to establish if they are candidates for potential curative surgeries. Unfortunately, a large proportion of patients with drug-resistant epilepsy are poor surgical candidates due to a seizure focus located in eloquent cortex, multifocal epilepsy or inability to identify the zone of ictal onset. An alternative treatment modality for these patients is neuromodulation. Here we present the evidence, indications and safety considerations for the neuromodulation therapies in vagal nerve stimulation (VNS), responsive neurostimulation (RNS), or deep brain stimulation (DBS).
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Affiliation(s)
- Natalia Rincon
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Donald Barr
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Naymee Velez-Ruiz
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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39
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Löscher W, Klein P. New approaches for developing multi-targeted drug combinations for disease modification of complex brain disorders. Does epilepsy prevention become a realistic goal? Pharmacol Ther 2021; 229:107934. [PMID: 34216705 DOI: 10.1016/j.pharmthera.2021.107934] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
Over decades, the prevailing standard in drug discovery was the concept of designing highly selective compounds that act on individual drug targets. However, more recently, multi-target and combinatorial drug therapies have become an important treatment modality in complex diseases, including neurodegenerative diseases such as Alzheimer's and Parkinson's disease. The development of such network-based approaches is facilitated by the significant advance in our understanding of the pathophysiological processes in these and other complex brain diseases and the adoption of modern computational approaches in drug discovery and repurposing. However, although drug combination therapy has become an effective means for the symptomatic treatment of many complex diseases, the holy grail of identifying clinically effective disease-modifying treatments for neurodegenerative and other brain diseases remains elusive. Thus, despite extensive research, there remains an urgent need for novel treatments that will modify the progression of the disease or prevent its development in patients at risk. Here we discuss recent approaches with a focus on multi-targeted drug combinations for prevention or modification of epilepsy. Over the last ~10 years, several novel promising multi-targeted therapeutic approaches have been identified in animal models. We envision that synergistic combinations of repurposed drugs as presented in this review will be demonstrated to prevent epilepsy in patients at risk within the next 5-10 years.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
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40
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Ebrahimi T, Tafakhori A, Hashemi H, Ali Oghabian M. An interictal measurement of cerebral oxygen extraction fraction in MRI-negative refractory epilepsy using quantitative susceptibility mapping. Phys Med 2021; 85:87-97. [PMID: 33984822 DOI: 10.1016/j.ejmp.2021.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Oxygen extraction fraction (OEF) can be a factor to identify brain tissue's disability in epileptic patients. This study aimed to assess the OEF's level measurement in refractory epileptic patients (REPs) using a quantitative susceptibility mapping (QSM) method and to determine whether the OEF parameters change. METHODS QSM-OEF maps of 26 REPs and 16 healthy subjects were acquired using 3T MRI with a 64-channel coil. Eighteen regions-of-interest (ROIs) were chosen around the cortex in one appropriate slice of the brain and the mean QSM-OEF for each ROI was obtained. The correlations of QSM-OEF among different clinical characteristics of the disease, as well as between the patients and normal subjects, were also investigated. RESULTS QSM-OEF was shown to be significantly higher in REPs (44.9 ± 5.8) than that in HS (41.9 ± 6.2) (p < 0.05). Mean QSM-OEF was statistically lower in the ipsilateral side (44.5 ± 6.6) compared to the contralateral side (46.4 ± 6.8) (P < 0.01). QSM-OEF was illustrated to have a strong positive correlation with the attack duration (r = 0.6), and a moderate negative correlation with the attack frequency (r = -0.3). Using an optimized support vector machine algorithm, we could predict the disease in subjects having abnormal OEF values in the brain-selected-ROIs with sensitivity, specificity, AUC, and the precision of 0.96, 1, 0.98, and 1, respectively. CONCLUSIONS The results of this study revealed that QSM-OEF of the REPs' brain is higher than that of HS, which indicates that QSM-OEF is associated with disease activity.
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Affiliation(s)
- Tayyebeh Ebrahimi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Tafakhori
- Iranian Center of Neurological Research (ICNR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Oghabian
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Molecular and Cellular Imaging, Tehran University of Medical Science, Tehran, Iran.
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Wang M, Zhang Z, Liu D, Xie W, Ma Y, Yao J, Zhu L, Liu M, Sheng S, Lian X. Educational attainment protects against epilepsy independent of cognitive function: A Mendelian randomization study. Epilepsia 2021; 62:1362-1368. [PMID: 33818779 DOI: 10.1111/epi.16894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Observational studies have suggested that increased levels of education and cognition are associated with a reduced risk of epilepsy. However, such associations are easily influenced by confounding or reverse causality. Hence, we conducted a two-sample univariable and multivariable Mendelian randomization (MR) to estimate the total and independent causal effects of educational attainment and cognition on epilepsy risk. METHODS We performed MR estimates on International League Against Epilepsy (ILAE) Consortium genome-wide association study (GWAS) data (15 212 epilepsy cases and 29 677 controls). We then validated the results in FinnGen (3424 epilepsy cases and 110 963 controls) and applied meta-analysis to all the results. RESULTS In the meta-analysis of the ILAE and FinnGen results, genetically determined increased educational attainment was associated with a reduced risk of epilepsy (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.80-0.88; P < .001). Similarly, genetically determined increased cognitive function was associated with a reduced risk of epilepsy (OR 0.94, 95% CI 0.88-1.00, P = .043). When educational attainment and cognitive function were included in the same multivariable MR, only educational attainment was still associated with a reduced risk of epilepsy (OR 0.88, 95% CI 0.81-0.95, P = .002). SIGNIFICANCE This MR study provides evidence to support that increased educational attainment can reduce the risk of developing epilepsy independent of cognitive function.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhizhong Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dandan Liu
- Department of Geriatrics, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xie
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yazhou Ma
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianrong Yao
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Linfeng Zhu
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Meng Liu
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shiying Sheng
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xuegan Lian
- Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Li C, Ma W, Zhao Y, Wang H. Changes in the expression of endothelial monocyte‑activating polypeptide II in the rat hippocampus following status epilepticus. Int J Mol Med 2020; 47:699-707. [PMID: 33416103 PMCID: PMC7797450 DOI: 10.3892/ijmm.2020.4808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/10/2020] [Indexed: 11/08/2022] Open
Abstract
Endothelial monocyte-activating polypeptide II (EMAP II) is a sensitive marker of neurotoxic injury, the expression of which increases significantly under conditions of stress, such as hypoxia or apoptosis. Studies have confirmed the extensive apoptosis of nerve cells in the brain following status epilepticus (SE), and the occurrence of SE can confer a hypoxic state on cells. The purpose of the present study was to observe the changes in the expression of EMAP II, and in the numbers and tight junction protein levels of micro-vascular endothelial cells in the hippocampus of rats with pilocarpine-induced SE. The protein expression levels of EMAP II, CD31, zonula occludens 1 (ZO-1) and occludin in the hippocampus were determined by immunofluorescence and western blot analyses. It was found that almost 75.6% of the rats in the SE group developed Racine stage IV-V seizures at approximately 44.7±18.8 min after the pilocarpine administration, and the 24-h mortality rate was almost 10.4%. The weight of the rats in the SE group was significantly decreased within 24 h following SE. Immunofluorescence staining revealed a low EMAP II expression in the hippo-campus of the rats in the control group; however, the numbers of EMAP II-positive cells were significantly increased in the SE group from 2 h to 21 days. The trend of EMAP II protein expression was consistent with that obtained with immunofluorescence staining. The numbers of CD31-positive microvascular endothelial cells were significantly increased from 24 h to 21 days compared with the levels in the control group. The protein expression of ZO-1 and occludin was most significantly decreased in the SE group. On the whole, the present study demonstrated that the expression of EMAP II in the rat hippocampus was upregulated in the SE model, which may promote angiogenesis and alter the TJ integrity of brain microvascular endothelial cells, with an increased number of CD31-positive microvascular endothelial cells and a decreased expression of ZO-1 and occludin.
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Affiliation(s)
- Chun Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Weining Ma
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110022, P.R. China
| | - Yajuan Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hua Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Singh G, Singhal S, Sharma S, Paul BS, Bansal N, Chaudhary A, Sharma S, Bansal RK, Goraya JS, Setia RK, Sander JW. Clinical characteristics of epilepsy in resource-limited communities in Punjab, Northwest India. Epilepsia Open 2020; 5:582-595. [PMID: 33336129 PMCID: PMC7733663 DOI: 10.1002/epi4.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics of a community-based epilepsy cohort from resource-limited communities in Punjab, Northwest India. METHODS The cohort was gathered following a two-stage screening survey. We cross-sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness. RESULTS The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug-resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years. SIGNIFICANCE Existing classifications schemes should be better suited to field conditions in resource-limited communities in low- and middle-income countries. The finding of drug-resistant epilepsy in nearly at least a third in a community-based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
- Department of NeurologyDayanand Medical CollegeLudhianaIndia
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sachi Singhal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | | | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Anurag Chaudhary
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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Carpio A. The Association between Neurocysticercosis and Epilepsy. Am J Trop Med Hyg 2020; 103:1335-1336. [PMID: 32896235 PMCID: PMC7470567 DOI: 10.4269/ajtmh.20-0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zoonotic and vector-borne parasites and epilepsy in low-income and middle-income countries. Nat Rev Neurol 2020; 16:333-345. [PMID: 32427939 DOI: 10.1038/s41582-020-0361-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Zoonotic and vector-borne parasites are important preventable risk factors for epilepsy. Three parasitic infections - cerebral malaria, Taenia solium cysticercosis and onchocerciasis - have an established association with epilepsy. Parasitoses are widely prevalent in low-income and middle-income countries, which are home to 80% of the people with epilepsy in the world. Once a parasitic infection has taken hold in the brain, therapeutic measures do not seem to influence the development of epilepsy in the long term. Consequently, strategies to control, eliminate and eradicate parasites represent the most feasible way to reduce the epilepsy burden at present. The elucidation of immune mechanisms underpinning the parasitic infections, some of which are parasite-specific, opens up new therapeutic possibilities. In this Review, we explore the pathophysiological basis of the link between parasitic infections and epilepsy, and we consider preventive and therapeutic approaches to reduce the burden of epilepsy attributable to parasitic disorders. We conclude that a concerted approach involving medical, veterinary, parasitological and ecological experts, backed by robust political support and sustainable funding, is the key to reducing this burden.
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Punia V, Fitzgerald Z, Zhang X, Huynh H, Bena J, Morrison S, Newey CR, Hantus S. Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study. Ann Clin Transl Neurol 2019; 6:2230-2239. [PMID: 31657134 PMCID: PMC6856614 DOI: 10.1002/acn3.50925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
Objective This study was designed to investigate if highly epileptic electroencephalogram (EEG) findings in patients with acute brain injury increase the long‐term risk of epilepsy development. Methods Adults patients, lacking epilepsy history, with electrographic seizures or lateralized periodic discharges (LPDs) (cases) were identified and matched based on age, mental status, and etiology with the ones lacking any epileptiform activity (controls) on continuous EEG (cEEG) during hospitalization. The primary outcome of clinical seizures after hospital discharge and their antiepileptic drug (AED) status was determined using a telephonic interview. Logistic regression models using generalized estimating equations to account for the matched nature of the data were performed. Results A total of 70 cases [16 (22.9%) “LPDs only,” 34 (48.6%) “electrographic seizure only,” and 20 (28.6%) “both”] and controls were enrolled. A total of 22 (31.4%) cases developed epilepsy after a mean follow‐up duration of 20.6 ± 5.0 months compared to three (4.3%) controls. After adjusting for cEEG indication and follow‐up duration, the odds of cases developing epilepsy were almost 15 times higher compared to the controls (OR = 14.8, 95% CI = 2.4–92.3, P = 0.004). This elevated risk was despite a 10 times higher likelihood of cases to be taking AEDs at the last follow‐up (OR = 10.34, 95% CI = 3.7–29, P < 0.001). Interpretation Highly epileptic EEG findings in patients with acute brain injury may serve as prognostic biomarkers of epilepsy development. Although prospective studies are required to confirm our findings, it seems that with epilepsy developing in almost one‐third cases in less than 2‐year follow‐up period, such patients may potentially be ideal candidates for epilepsy prevention clinical trials.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Zachary Fitzgerald
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Xiaoming Zhang
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Huan Huynh
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Shannon Morrison
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Christopher R Newey
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106.,Neurocritical Care, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
| | - Stephen Hantus
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44106
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Ułamek-Kozioł M, Czuczwar SJ, Januszewski S, Pluta R. Ketogenic Diet and Epilepsy. Nutrients 2019; 11:nu11102510. [PMID: 31635247 PMCID: PMC6836058 DOI: 10.3390/nu11102510] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022] Open
Abstract
Currently available pharmacological treatment of epilepsy has limited effectiveness. In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.
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Affiliation(s)
- Marzena Ułamek-Kozioł
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland.
- First Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland.
| | - Stanisław J Czuczwar
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Sławomir Januszewski
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland.
| | - Ryszard Pluta
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland.
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Christensen J, Pedersen HS, Fenger-Grøn M, Fann JR, Jones NC, Vestergaard M. Selective serotonin reuptake inhibitors and risk of epilepsy after traumatic brain injury - A population based cohort study. PLoS One 2019; 14:e0219137. [PMID: 31323024 PMCID: PMC6641473 DOI: 10.1371/journal.pone.0219137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Traumatic brain injury (TBI) is common and associated with a marked increased risk of developing epilepsy. Animal studies indicate that treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of epilepsy after TBI. The aim of this study was to investigate whether use of SSRIs modifies the risk of epilepsy after TBI. METHODS This was a cohort study of 205,715 persons, who suffered a TBI in Denmark from 1996 to 2013. For each person with TBI, we matched 10 reference persons (N = 2,057,150) who were alive on the day of TBI and who had the same age and gender but had no history of TBI. We used a stratified Cox regression to calculate the relative risk of epilepsy after TBI for persons exposed to TBI, SSRI or both after adjustment for income, civil status, medical and neurological comorbidities, severe mental disease, and substance abuse. RESULTS The risk of epilepsy was 5.61 times higher for persons who used SSRI at time of TBI (adjusted Hazard Ratio (aHR): 5.61 (95% CI: 4.88; 6.45)), 3.23 times higher for persons who had a TBI but did not use SSRI at time of TBI (aHR: 3.23 (95% CI: 3.12;3.35)), and 1.31 times higher for persons who used SSRI but had no TBI (aHR: 1.31 (95% CI: 1.18; 1.45)) compared to persons unexposed to both TBI and SSRI. CONCLUSIONS This large population based cohort study showed that people using SSRI at the time of a TBI had higher risk of developing epilepsy compared to people not using SSRI at the time of TBI. The results are in line with those of animal studies and calls for further studies to evaluate whether the association is due to SSRIs or to the underlying disease (e.g. depression or anxiety).
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Affiliation(s)
- Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Henrik Schou Pedersen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jesse R. Fann
- Department of Psychiatry, University of Washington, Seattle, Washington, United States of America
| | - Nigel C. Jones
- Department of Medicine (RMH), University of Melbourne, Melbourne Brain Centre, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University and Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mogens Vestergaard
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy. Indian J Pediatr 2019; 86:608-616. [PMID: 31177510 DOI: 10.1007/s12098-019-02946-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others. These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.
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Schmidt D. Commentary to Bentes et al. "Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patients". Epilepsia Open 2018; 3:127-128. [PMID: 29881792 PMCID: PMC5983142 DOI: 10.1002/epi4.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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